r/emergencymedicine • u/Content-Ninja-2478 • Jan 22 '25

Advice First infant code

Had my first infant code the other day. Home birth that didn’t go well, 39 weeks, Nuchal cord, baby was grey at arrival, continued to work baby for approx 40ish mins, asystole the whole time. A very short moment of silence for babe and No debrief. I feel like the baby deserved more than that. I still feel sick about it. I called my hospitals counseling services and broke down.. I just wish we debriefed as a team, I know it’s busy in the ER and we have to pick up and move on but idk. I don’t even know if baby was boy or girl since it had a diaper on.. that also bothers me. This sucks

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u/Loud-Bee6673 ED Attending Jan 22 '25

I don’t know if this helps or not, but by the time that infant got to your hospital, the outcome was set in stone. Coding a neonate isn’t like any other resuscitation we do, and if you don’t get some response within the 10 minutes after birth, you are very unlikely to have a positive outcome. I understand why the code went as long as it did, but it was too long.

I know that doesn’t make it ok. I have been doing PEM for a while now and it is never ok, it doesn’t get easier. This is where you rely on your support system whether it be friends, family, a hike in the woods, church, or meditation. I take some time to acknowledge the loss, that it is hard on me and my team but nothing compared to the impact on the family. That we did our best. That I am still here are I have more to do, so I go back to work the next day. And the next.

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u/EBMgoneWILD ED Attending Jan 22 '25

I don't disagree with your sentiment, but at the same time I've worked at enough hospitals that if I called a newborn at 10 minutes I would be in HR the next day answering complaints about why I didn't try harder.

Also, we always try harder on the young kids. Human nature and they're more resilient anyway.

Hell, one of my coworkers got written up by the ACLS instructor because at the end of a code, he asked "does anyone else have any suggestions" like it mentions IN ACLS and they took it to mean he didn't know what he was doing and therefore was unsafe to practise.

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u/3RingCircusForever Jan 22 '25

Just as using that statement to reach out to our colleagues is taught in ACLS, ceasing resuscitation of a neonate in asystole after 10 minutes of quality resuscitation is taught by NRP, due to extremely poor prognosis. Highly recommend taking the Neonatal Resuscitation Program or similar class to all clinicians unfamiliar with neonatal resuscitation.